Abstract
After the introduction of the Gastrointestinal Cancer Intergroup Trial (INT 0116) [1], the largest phase III trial comparing surgery alone versus postoperative chemoradiotherapy (CRT) in gastric cancer, radiation therapy (RT) has attracted increasing attention as a treatment modality for patients with gastric cancer. Before INT 0116, RT has not been frequently considered as a modality for gastric cancer with several reasons. First, the radiation effect has been known to be inferior in adenocarcinoma compared with squamous cell carcinoma or undifferentiated carcinoma. Second, the gastrointestinal (GI) complications of RT have been exaggerated. Third, the gastric cancer can be considered as a systemic disease rather than localized disease because the main patterns of failure are peritoneal seeding or liver metastasis after radical resection. However, with the several clinical studies showing the additional effect of preoperative or postoperative RT and the development of radiation techniques such as three-dimensional conformal radiotherapy or intensity-modulated radiotherapy (IMRT) decreasing radiation-induced bowel complications, the application of RT to patients with gastric cancer is now gradually increasing.
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